Treatment Options for OA Flashcards
What joint is spared in osteoarthritis?
Ankle
What is osteoarthritis?
Clinical syndrome of joint pain accompanied by varying degrees of functional limitation and reduced quality of life.
What are the most commonly affected joints?
Knees, hips and small hand joints
OA isn’t always caused by ageing. What else might it be caused by? (2)
Trauma
Metabolic conditions
Describe what is meant by ‘OA is a metabolically active repair process’.
The cartilage is trying to repair the damage, but it isn’t able to. It causes localised loss of cartilage and remodelling of adjacent bone.
What are the symptoms of OA? (5)
Joint pain (with use) Morning stiffness lasting <30 minutes Joint instability or buckling Loss of function Crepitus on motion
What are the signs of OA? (5)
Bony enlargement at affected joints Limited range of motion Crepitus on motion Mal-alignment and/or joint deformity Muscle atrophy/weakness
What do all OA patients have in terms of management?
Information and advice (education, weight loss, exercise, lifestyle alterations)
What do some OA patients have in terms of management?
Simple non-surgical interventions – NSAIDs, other drugs, physiotherapy, occupational therapy, orthoses, other aids
Advanced non-surgical interventions - injections
What do few OA patients have in terms of management?
Surgery (joint preserving) – osteotomy, resurfacing
Surgery – partial or total joint replacement
What are the key priorities for non-pharmacological care? (4)
- Exercise
- TENS (transcutaneous electrical nerve stimulation) as an adjunct for pain relief
- Acupuncture
- Aids and devices to give stability e.g. orthopaedic insoles and walking sticks
- Diet
- Nutriceuticals
What are the benefits of exercise for OA? (4)
Local muscle strengthening
Improves general aerobic fitness
Improves weight loss
Improves bone health and mass
What are nutriceuticals for OA? (3)
Omega-3 rich foods
Chondroitin sulphate supplements
Glucosamine supplements
What is the arthritis prevalence in healthy weight people?
16.9%
What is the arthritis prevalence in overweight people?
19.8%
What is the arthritis prevalence in obese people?
29.6%
How is OA managed pharmacologically? (3)
Oral analgesics - paracetamol and/or topical NSAID, topical capsaicin
Oral NSAID/COX-2 inhibitor - used at lowest effective dose for shortest possible period, standard NSAID 1st then COX-2
Intra-articular injections (corticosteroid injections)
Name a COX-2 inhibitor.
Celecoxib
When are patients considered for referral for surgery?
When pain, stiffness and reduced function have a substantial impact on quality of life i.e. they are waking at night because of the pain.
What are the orthopaedic treatment options? (6)
Arthroscopic lavage Arthroscopic lavage plus debridement Microfracture Mosiacplasty (osteochondral transplant) Chondrocyte grafts Joint replacement
What is done in microfracture surgery?
Creating damage to the articular cartilage in order to induce it to repair itself. Drill into the subchondral bone down to the bone marrow (as this is a pluripotent stem cell population, so can differentiate into chondroblasts).
How long does it take the cartilage to recover from microfracture surgery?
Who has the best results?
4-6 months
Peopleunder age 40 with a recent cartilage injury and those who are not overweight
What is done in arthroscopic lavage and debridement surgery?
Arthroscopic lavage means washing out the joint, and debridement means getting rid of debris. Cleans the surfaces and remove any bits of loose cartilage from the joint that might cause the joint to lock or rub onto surface of the bone. Debridement tidies up the edges so we have a smoother surface.
How many patients who had debridement and washout were pain-free at 1 year?
How many were who just washout?
80-90%
14%
